About The Cornea

The cornea is the clear, outer surface of the eye. The shape of the cornea plays an important role in focusing light on the retina. A standard shaped cornea and a healthy, clear lens allows light to focus clearly. If the cornea becomes cloudy or if the cornea becomes irregular in shape, vision can be impaired.

Seeing a cornea specialist at the recommendation of your hometown eye doctor cannot only change your vision, it may transform your life. Your vision is precious. The ophthalmologists at Vance Thompson Vision can detect and treat corneal disease or trauma, when wearing glasses or contact lenses are no longer meeting your needs.

Reviews

"Amazing team , Bozeman is lucky to have Dr. Swan and his team. Extremely thorough, detailed and it’s obvious the level of expertise and technology is second to none."

- M.B. / Google / Feb 28, 2019

"The staff was amazing from the first phone call to surgery day. If you are considering laser eye surgery you don't need to look further: this is world class technology and customer service right in Bozeman. I had PRK on 1/24/19 with Dr. Swan which was a painless, simple and quick procedure (despite my fears of it). I had -5.25 with astigmatism in both eyes and could tell the vision improvement the same day, drove 5 days later and one week out had major improvement in vision. My aftercare doctor has mentioned how smooth my eyes are and how well they are healing due to Dr Swan's technique. [Tips for PRK: plan to spend 2-3 days relaxing in a dark room (audio books and black out curtains a must!), pain happens after surgery so take the Tylenol immediately to keep up on pain management, and keep up on the eyes drops]"

- J.W. / Google / Feb 14, 2019

"The entire Vance Thompson team is purely wonderful! Dr. Swan, Bri, Susan, Kim and the entire crew make each patient feel comfortable, welcome, and well cared for at every interaction! I can't recommend these guys enough!!!"

- R.F. / Google / Feb 13, 2019

"Kind and competent best describes them. I felt cared for and thT my surgical concerns became their concerns."

5.0

Candidates for Consultations

Patients suffering vision loss from a diseased or irregularly shaped cornea, such as when a patient has keratoconus, are good candidates for one of the many surgical or non-surgical cornea treatments.

Evaluation & Diagnosis

Once you have made an appointment for your initial consultation, we will perform an evaluation to create a custom treatment plan designed for you. At your consultation, be prepared to discuss your symptoms, personal health history, family medical history, and undergo several diagnostic screenings. At Vance Thompson Vision, our goal is to utilize state-of-the-art technology to get the most accurate diagnosis to provide you with the most comprehensive eye care.

Many of the disorders associated with the cornea are genetically passed from family member to family member, but conditions can also be from an injury to the cornea from trauma or excessive rubbing of the eye. A patient with an unhealthy cornea can experience distorted vision, light sensitivity, irritation, blurring of vision, swelling, and/or glare. Vision loss (including night vision) can be improved with a surgical and non-surgical intervention to treat conditions involving the cornea.

Treatment Options

Keratoconus

Keratoconus is an eye condition where the cornea becomes thin and bulges forward. A healthy cornea maintains a round dome shape. An eye with keratoconus develops a cone-like bulge, and this change in the corneal shape distorts vision. Karatoconus can make it difficult for a person to drive, read, and watch television.

With treatment, keratoconus can resolve and heal, but scarring on the eye can remain and diminish the vision quality. The keratoconus treatment method depends on the condition's severity. In early phases of the disease, eye doctors can treat it with glasses or contact lenses. The doctor may use specialty contact lenses that help to artificially smooth the eye surface so the eye can reflect light evenly.

Ideally all patients would be treated with corneal cross-linking prior to their disease progressing. As keratoconus progresses the cornea eventually becomes too thin to cross-link and the patient may need a cornea transplant to replace the damaged cornea with a healthy donor cornea. A less invasive method of keratoconus treatment involves the implantation of corneal inserts, such as Intacs. Corneal inserts are small segments placed in the cornea to flatten the cornea when contacts and glasses can no longer correct the patient's vision and delay the need for a corneal transplant.

Cross-linking

Corneal collagen cross-linking is a method of treatment for ectasia, a devastating disease characterized by an irregularly-shaped cornea, or eye surface. People who suffer from ectasia experience a bulging and protrusion of their cornea in a cone-like shape. Ectasia often occurs in patients with keratoconus (KCN) and pellucid marginal degeneration (PMD), disorders associated with the thinning of the cornea region. In patients with ectasia, the surface of their eye begins to protrude at the weakest and thinnest point, which significantly decreases the patient's ability to see clearly.

Our corneas naturally contain cross-links between collagen fibers in order to maintain shape and strength. Ectasia is a result of not enough of these cross-links to support the cornea, leading to the corneal irregularities. Corneal cross-linking uses a combination of riboflavin and ultraviolet light to create additional cross-links, promoting corneal stability and strength. This procedure is minimally invasive, so it does not involve any surgical incisions into the eye.

Through corneal cross-linking, the collagen fibrils in the cornea chemically bond together to halt the thinning process and restore vision acuity. The primary goal of cross-linking for keratoconus patients is to strengthen and stiffen the corneal fibers in order to decrease progression of keratoconus.

Fuchs' Dystrophy

Fuchs' dystrophy is an inheritable disease that affects the cornea, the clear front area of the eye. The disease causes the cornea to swell because the inner layer of the cornea, the endothelium, begins to diminish. Endothelial cells regulate the correct amount of fluid in the eye by pumping out fluid. When fewer of these cells line the eye's inside surface, fluid begins to build up in the cornea. As the cornea swells with the extra fluid, the patient's vision worsens. As the disease worsens, the cornea can develop blisters on the cornea, a condition called bullous keratopathy.

No prevention for Fuchs' dystrophy is known. Doctors treat the disease based on its stage. Removing excess water from the cornea with hypertonic eye drops is usually not an effective treatment for patients but can be tried in early stages of the disease.

If a patient has high eye pressure and Fuchs' dystrophy, glaucoma eye drops may help to decrease eye pressure. High eye pressure can cause Fuchs' dystrophy to progress further, so maintaining a low eye pressure is important for patients with both conditions.

Once Fuchs' dystrophy reaches a point where it significantly impairs a patient's vision, then a cornea transplant can restore vision. An alternative to a full corneal transplant is a transplant of only the inner endothelial layer of the eye. The procedure options, DSEK or DMEK, replace the affected cells while keeping the outer layer of the eye intact and providing better visual recovery.

Partial-Thickness Corneal Transplant (DSEK and DMEK)

Descemet's Stripping Endothelial Keratoplasty (DSEK) and Descemet's Membrane Endothelial Keratoplasty (DMEK) are procedures for replacing only the two most posterior or inner layers of the cornea with donor tissue. Partial-thickness corneal transplants provide a transplant technique for patients when the interior endothelial layer of the cornea has broken down.

In partial-thickness corneal transplants, the surgeon first removes the existing endothelial layer from the patient's cornea. The surgeon then uses a small incision to insert the donor tissue. Using a gas or air bubble, the surgeon unfold the donor cornea and places it correctly. The incision may need one or two sutures, but it often seals on its own.

Nationally DMEK is a common method for partial-thickness corneal transplants. Patients with seerely damaged corneas because of an endothelial disorder such as Fuchs' dystrophy can experience improved vision through DMEK. Rather than replacing the full cornea with a donor cornea, DMEK replaces only the interior layer of the cornea, called the endothelium. With DMEK, patient are less likely to reject the donor tissue than with the thicker DSEK, and the visual clarity after surgery can be better.

DSEK is similar to DMEK, and it is a partial-thickness corneal transplant that uses a much thinner donor tissue than a complete transplant. DSEK replaces the damaged endothelial layer, creating a healthy endothelial layer of the cornea. Some surgeons use donor tissues that are already prepared so the tissue is ready for implantation.

Cornea Transplant

A cornea transplant is a surgical procedure where a surgeon replaces part of a patient's diseased cornea, creating the opportunity for restored vision. Patients with a damaged cornea that prevents acceptable vision are candidates for corneal transplantation. This procedure allows patients to receive clear vision through a full replacement of the cornea with a donor cornea.

A cornea transplant involves replacing the center part of the cornea, called a button, with a donor graft. The surgeon begins by carefully removing the diseased central area of the cornea. The surgeon places a matching donor button in its place. The surgeon then uses stitches to connect the donor tissue and the existing tissue if the transplant is full thickness. Through cornea transplants, patients who have experienced severe vision loss because of damaged corneas can have a renewed vision with a properly-shaped cornea.

Procedure Information

Assess Your Cornea at VTV

Our Vance Thompson Vision ophthalmologists and optometrists are internationally recognized for their excellence in cornea transplant surgery. Rest assured that your vision is in good hands. The Vance Thompson Vision community will help you understand your vision condition and the different options for treating your eyes so that you can enjoy life with your sight intact. If you are interested in discussing cornea problems with our doctors in Sioux Falls, SD, please feel free to call our office directly.